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Prevalence of Covert Hepatic Encephalopathy in A Tertiary Care Centre

Rahul Pathak1, Pukar Ghimire2, Sabin Thapaliya3

  • 1Department of Gastroenterology, Institute of Medicine, Maharajgunj, Nepal.

JNMA; Journal of the Nepal Medical Association
|April 27, 2020
PubMed
Abstract

Insights

Minimal Hepatic Encephalopathy (MHE) is common in chronic liver disease patients, often missed due to lack of symptoms. Early screening with simple tests like the Number Connection Test (NCT) can improve diagnosis and treatment.

Area of Science:

  • Hepatology
  • Neurology
  • Clinical Diagnostics

Background:

  • Minimal Hepatic Encephalopathy (MHE) affects 30-50% of patients with Hepatic Encephalopathy.
  • Early identification and treatment of MHE can delay the progression to Overt HE.
  • Current screening methods are time-consuming, limiting clinical practice.

Purpose of the Study:

  • To determine the prevalence of covert hepatic encephalopathy, including MHE, in patients with chronic liver disease.
  • To evaluate the utility of the Number Connection Test (NCT) for diagnosing MHE.
  • To highlight the need for active screening in clinical settings.

Main Methods:

  • A descriptive cross-sectional study was conducted.
  • The Number Connection Test (NCT) in Devanagari script was used to diagnose covert HE and MHE.
  • The study population comprised patients with chronic liver disease.

Main Results:

  • The prevalence of covert hepatic encephalopathy was 58.3% (90% CI: 58.23-58.37%).
  • Out of 96 patients diagnosed with HE (mean age 49.6±11.8 years, 71.9% male), 41.7% had overt HE, while MHE was most prevalent (37.5%).
  • Alcohol was the primary cause of chronic liver disease in 88.5% of patients.

Conclusions:

  • Minimal HE is highly prevalent in cirrhotic patients but often asymptomatic and overlooked.
  • The Number Connection Test (NCT) is an effective and easy-to-administer tool for identifying MHE.
  • Active screening using simple tests like NCT is crucial for early MHE detection and management.
Keywords:
chronic liver disease; covert hepatic encephalopathy; minimal hepatic encephalopathy; number connection test; overt hepatic encephalopathy.

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